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Green Hills with Blue Sky

New Client Forms

If you are a new client, please print and complete the following forms and bring them to your first therapy session.  Filling out the forms prior to your first session saves us considerable time, providing you a better opportunity to share your reasons for coming into therapy.

  • Disclosure statement
  • HIPAA Notice & Acknowledgement 
  • Fee Contract
  • Client Information 
  • Insurance Information
  • Credit Card Authorization 

In addition to the forms listed above, if you would like me to coordinate care with another provider (for example: your psychiatrist, primary care physician, etc.), then you will also need to complete this form to authorize release of psychotherapy information and bring it with you to your first therapy session.

  • Release of Information

 

Disclosure  
HIPAA - Notice of Provider Practices + Acknowledgement  
Fee Contract  
Client Information  
Insurance Information
 
 
Release of Information  
Credit Card Authorization  

 

Note: To download Adobe Acrobat Reader for free, click here.

 

Helpful Forms

Click here to view and print forms for your appointment.

CLICK HERE